Objectives: Focal intimal disruption is a risk factor for adverse aorta-related events in acute type B intramural haematoma patients. This study evaluated the impact of focal intimal disruption on overall survival with a selective intervention strategy for large or growing focal intimal disruptions. Additionally, this study evaluated the risk factors associated with the growth of focal intimal disruption.
Methods: This retrospective study included all consecutive patients admitted for acute type B intramural haematoma between November 2004 and April 2021. The primary outcome was overall survival. The secondary outcome was cumulative incidence of composite aortic events and the growth of focal intimal disruption. The latter was calculated on centerline-reconstructed computed tomography images.
Results: A total of 105 patients were included. A total of 106 focal intimal disruptions were identified in 73 patients (73/105, 69.5%). The 1- and 5-year cumulative incidence rates of composite aortic events were 36.2% and 39.2%, respectively. The 1- and 5-year overall survival were 93.3% and 81.5%, respectively. Initial maximal aortic diameter and large focal intimal disruption during acute phase were significant risk factors for composite aortic event, but not risk factors for overall survival. Early appearance interval of focal intimal disruption was a significant risk factor for growth of focal intimal disruption.
Conclusions: With a selective intervention strategy for large or growing focal intimal disruptions, the presence of large focal intimal disruption during acute phase does not affect overall survival. Early appearance interval was associated with the growth of focal intimal disruption.
Keywords: Aortic intramural hematoma; aortic intervention; focal intimal disruption; ulcer-like projection.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.